Provider Demographics
NPI:1891897450
Name:COHEN, WILLIAM B (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:B
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:149 S BARRINGTON AVE
Mailing Address - Street 2:SUITE 806
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3310
Mailing Address - Country:US
Mailing Address - Phone:310-788-7311
Mailing Address - Fax:310-889-1912
Practice Address - Street 1:8733 BEVERLY BLVD
Practice Address - Street 2:STE 310
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1827
Practice Address - Country:US
Practice Address - Phone:310-887-0500
Practice Address - Fax:310-889-1912
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG205652086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G205650Medicaid
756231038OtherRAILROAD MEDICARE
756231038OtherRAILROAD MEDICARE
CA00G205650Medicaid